Femoroacetabular Impingement

What is Femoroacetabular Impingement?

Femoroacetabular impingement (FAI) is a condition that results from abnormal contact between the top of the thigh bone (femoral head) and the outside part of the hip socket (acetabulum). Damage can occur to the surfaces of the hip joint over time as a result of repeated abnormal contact during activities and range of motion of the hip. (The animation to the left demonstrates this.)

What causes Femoroacetabular Impingement?

The cause of FAI is not known in most cases. Some doctors believe that heavy physical activities, such as football and weight lifting, or heavy labor before the body stops growing can contribute to FAI. Some childhood problems, such as Legg-Calve-Perthes disease or slipped capital femoral epiphysis (SCFE), can lead to FAI.

There are two types of FAI, Cam and Pincer. Most patients have a mixed pattern with both cam and pincer deformities. Cam FAI is the result of an abnormally shaped upper femur. The abnormal 'bump' on the upper femur can cause uneven contact with the hip socket, potentially damaging the cartilage. Pincer FAI is the result of a socket that is too deep or oriented in an incorrect direction. This can lead to pinching of the cartilage rim (labrum) of the socket with movement.

Symptoms and Treatments

What are the symptoms of Femoroacetabular Impingement?

Patients with FAI typically complain of hip pain and a loss of motion in the hip joint. Symptoms related to FAI can include cartilage damage, labral tears, early hip arthritis, hyperlaxity (too much mobility in the hip), hip pain and low back pain. Pain can occur during physical activities such as walking or running. Some patients report pain after prolonged sitting. Pain can be located in the groin, thigh or knee.

Signs of FAI can begin in the adolescent years but it becomes much more common in young and middle-age adults. These signs may get worse with age.

How is Femoroacetabular Impingement diagnosed?

Your doctor may diagnose FAI after taking a thorough medical history, followed by a physical examination and X-ray. Magnetic resonance imaging (MRI) or a computed tomography (CT) scan can be used to better assess the shape of the upper femur and socket and to confirm the amount of damage to the cartilage in the joint.

Treatment of Femoroacetabular Impingement (FAI)

Treatment can include conservative care, such as:

Medications

Physical therapy

Limiting physical activities

Surgery is often needed and may be minimally invasive (arthroscopic). Some FAI surgery can require an open surgical method depending on the extent of the damage to the cartilage.

Patient Testimonials

Teen Regains Mobility

It is an athlete's worst nightmare: the inability to play at peak performance. For Ryan Stuart, an athletic and intelligent teenager from Thomasville, Ga., this frustration was taken to a new level. Terrible pain, a loss of flexibility and a grinding feeling in the hips kept him from playing to his potential. It was an ordeal that would last four years and see the young man visit more doctors than he would care to remember.

Ryan had always excelled at sports. Baseball and football are his favorites, and he stood out as a catcher and offensive lineman, two positions that take a toll on the joints. During middle school, Ryan began to notice nagging pain in his legs and hips. He thought the symptoms were due to his active lifestyle. A doctor recommended Ryan rest for a year, and reluctantly he agreed. He said the decision drove him crazy.

"I loved playing sports," he said. "It was all I ever did."

In high school, Ryan continued to play, but the pain did not go away. A doctor ordered blood tests but was unable to find anything conclusive. After X-rays and more visits, Ryan's doctor still could not find the source of the pain and referred him to an orthopaedic specialist. Magnetic resonance imaging (MRI) scans, more X-rays and a full body bone scan were ordered. The results remained murky, and the best the doctor could do was to diagnose juvenile arthritis, which Ryan had previously tested negative.

At this point, both Ryan and his mother, Beth, were frustrated.

"It was hard watching my son going through this kind of pain and not be able to do anything about it," she said.

Ryan's medical odyssey then took him to Tallahassee, Fla., where more tests were ordered with the same disappointing result. Ryan's doctor then questioned whether the young man's symptoms were psychological. "He thought it was all in my head," Ryan said.

This was more than his mother could take. Ryan was ultimately referred to an Atlanta doctor who, after having Ryan endure another round of tests, told the young man he needed to stop playing football until they could find out what was wrong. Ryan took the news hard.

"I was absolutely crushed," he said.

Ryan was prescribed a powerful arthritis medicine that made him very sick but did not decrease the pain. Soon after, Ryan was referred to pediatric hip specialist Tim Schrader, M.D.

By this point, Ryan was mentally exhausted from the constant travel and the disappointment of not having any answers. During the four-hour trip from Thomasville to Atlanta, Beth tried to keep his spirits up.

At Children's, Dr. Schrader reviewed all of Ryan's MRI images and X-rays. He immediately ordered another round of X-rays, but rather than sending Ryan home to have his doctors perform the test, Dr. Schrader did them right away. After the images were taken, Ryan sat anxiously in the waiting room

"An entire year of searching and driving to different doctors, and my diagnosis came down to two 15-minute X-rays," he said.

Dr. Schrader, whom Ryan calls his "medical savior," had the answer-Ryan had femoroacetabular impingement (FAI). Dr. Schrader said surgical dislocation of the hip with acetabular rim trimming and a femoral head/neck osteoplasty-a type of hip surgery-would correct the problem. Ryan would then begin the long, slow rehabilitation process. Despite the enormity of the news, Ryan said he felt a huge sense of relief. Finally, he had an answer and a plan to regain his independence and live pain-free.

"The pain, doctor's visits and not knowing had defined my life for so long," he said. "Now, I could move forward."

Ryan actually had two surgeries, one on each hip, to fix his problem. He said that throughout his entire ordeal, his older brother and younger twin sisters supported him. But, it was his mother who rode the hundreds of miles and spent countless hours with Ryan to find the answer to his painful problem.

"She was with me every step of the way," he said. "When I got discouraged, when nobody could figure it out, she would say something to motivate me. She was my hero." Today, Ryan no longer plays football, but he does wrestle for the Thomas County Yellow Jackets. He has completed all of his high school classes early and is now taking college-level courses. Ryan has been accepted to the University of Alabama where he will study sports medicine.

When asked what advice she would give someone going through a similar situation, Beth does not hesitate to answer. "Don't ever give up. Your child is going through a tough time, and it's important to understand what he's going through. It can be a humbling experience, but keep going until you find your answer."

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3 related images

What are X-rays?

X-rays are made by using low levels of external radiation to produce images of the body, the organs, and other internal structures for diagnostic purposes. X-rays pass through body structures onto specially treated plates (similar to camera film) and a negative-type picture is made. The more solid a structure is, the whiter it appears on the film. For this reason, bones appear very white on an X-ray film, but less dense tissue such as muscle, blood, skin and fat appears darker. An X-ray provides a picture of inside the body by using special radioactive rays. An X-ray can show bones, tissues or parts of organs.